At Cabrillo and in other medical classrooms, cadavers replace 'virtual learning'

APTOS -- Twenty Cabrillo College students crowd around the cadaver in Robin McFarland's human anatomy class.

McFarland holds up the heart, points at a fleshy tube and asks, "What is this vessel?"

The class leans in for a closer look and responds in unison: "Aorta."

The body has no name -- only an ID number (12-117) and a brief description: male, 90 years old; primary cause of death, aspiratory pneumonia; contributing factor, Alzheimer's.

The cadaver came from UC San Francisco's Willed Body Program, which gets about 400 donated bodies every year from people who have left their remains to the medical school in the hope that their last bequest helps advance medicine.

Just a few years ago, there was a move toward "virtual learning" for medical students, including using 3-D digital models of the human body. But that trend appears to be reversing. Now there's a renewed emphasis on learning from human cadavers.

"Those things are great when used to enhance what the cadavers can actually show, but they can't replace the real experience of actually working with the real cadaver," said Andrew Corson, the program's director.

About a quarter of the donated bodies end up in high-end research labs. The rest are used in anatomy classes at UCSF's medical school and colleges and universities around Northern California.

The head of the cadaver in McFarland's lab is neatly wrapped in several layers of plastic so the face isn't visible. The skin on the torso, legs and arms has been removed to show the muscles underneath. On the hands, the skin is intact, beige from preservatives and covered with liver spots. The smell of formaldehyde permeates the lab. A couple of students slip Altoids mints under their tongues to combat the fume-induced nausea.

Patient No. 1

Most of the students in McFarland's anatomy class will go into nursing programs, so she thinks of the bodies as her students' first patients.

The students examine two cadavers, side by side. Next to the 90-year-old who suffered from Alzheimer's is 11-288, an 84-year-old man and longtime smoker who died of congestive heart failure. The students have spent months comparing the two bodies, understanding not just how they operated in life, but what led to the men's deaths.

"It means a lot more than learning about body parts," McFarland said. "It's a look into how people die, how the illnesses at the end of life affect the body."

McFarland found a small black growth on the tip of one of the smoker's lungs. She thinks it was an undiagnosed cancer.

Students also learn about the natural variations among the bodies they study, said Richard Baldwin, laboratory manager for the anthropology department at UC Santa Cruz. "You never know what you're going to get," he said. The organs, he noted, can be damaged by disease or have subtle differences in placement -- things that students won't see in a digital anatomy atlas, no matter how accurate it is.

Cabrillo College student Gordon Landon, a personal trainer and aspiring public health specialist, said the anatomy class helps him point precisely to a muscle and explain how an exercise is working it. But he admitted that the first day he spent with the cadavers, he was sick to his stomach and had to leave the lab or risk throwing up.

Natasha Frias, a kinesiology student, described her initial shock at seeing the bodies in the lab. "At first, I was taken aback. 'This is what I look like on the inside?'" she said.

Feeling of Loss

Baldwin has had several UCSC students who, reeling from the loss of a grandparent or other family member, decide to drop the class and return another year. Some never return.

In two or three years, after thorough study, the bodies will be returned to UCSF, along with every organ and tissue that was removed. Then they'll be cremated and the ashes scattered at sea.

Unlike other body donation programs, UCSF's program doesn't offer the option of returning bodies to family members. "We are very clear up front with families about that, and it is a deal-breaker for some families," Corson said. "We get that, and we completely respect it."

People with some infectious diseases such as tuberculosis, HIV and hepatitis B can't donate their bodies. Nor can people who weigh more than 250 pounds, because there's too much fat for students to get a good look at internal organs.

Despite the restrictions, there are 11,000 registered donors, though family members can also donate the bodies of the recently deceased.

Donation scandal

Scandals have marred body donation programs in the past. In 2004, the head of UCLA's Willed Body Program was accused of selling parts of donated bodies to a businessman who turned around and sold them to pharmaceutical and medical research companies. The program shut down for a year after the initial allegations, and the director was ultimately sentenced to four years in prison for grand theft and conspiracy to commit grand theft.

Now the UC Anatomical Donation Program, which oversees four other donation programs along with UCSF's, keeps a tight rein on all donated bodies and body parts. Every last shred of human tissue must be returned, regardless of how much the bodies have been dissected.

In the past three years, two students received widespread attention after being disciplined for disrespecting cadavers on Facebook -- one from Stony Brook University Medical Center in New York for posting photos of a cadaver and another from the University of Minnesota for writing demeaning comments about a cadaver.

Most students, though, feel a deep sense of gratitude to the people who have donated their bodies, said Adam Schwalje, a second-year medical student at UCSF.

Talk at start of year

In Schwalje's program, the school year starts with a discussion about working on the cadavers, including what kind of ethical responsibilities students have and what they should be prepared for emotionally. It ends with a memorial service for the donors.

In between, students spend hours on end with the cadavers and form a bond with them. "You wind up feeling almost kind of close with the body -- with the person," Schwalje said.

A former professional bassoon player, he played an arrangement of the Beatles' "Yesterday" with some of his classmates in last year's service. Others read poems or just talked about their year with the cadavers.

At the end of the semester at Cabrillo, McFarland's students write an essay about their experience. They often describe how their initial uneasiness about working with cadavers morphed into appreciation.

McFarland pulled a few of the essays from her files.

One reads: "I thank everyone dead or alive who made this such a wonderful learning experience."